Testosterone and Women: What the New Research Says in 2026

MARKABLE Research Team · May 2026 · 10 min read

Testosterone is the most abundant biologically active hormone in women throughout most of their lives, yet there is still no FDA-approved testosterone product for women in the United States. That gap between biology and available treatment is finally getting serious attention, driven by new research, clinical advocacy, and growing public demand.

For decades, the conversation about testosterone in women has been narrowly focused on sexual desire. The emerging science tells a broader story: testosterone is associated with mood regulation, cognitive function, energy, bone density, and cardiovascular health. As women lose approximately 50% of their testosterone production between their 20s and the menopausal transition, the effects can be far-reaching.

Testosterone in women: the basics

Women produce testosterone in the ovaries and adrenal glands. While women produce roughly one-tenth the amount men do, testosterone is nonetheless the most abundant active sex steroid in women, with levels exceeding those of estradiol at every stage of life.

Testosterone levels in women begin declining from the early 20s. By the time a woman reaches menopause, circulating testosterone levels have typically fallen by about 50% from their peak. For women who undergo surgical menopause (bilateral oophorectomy), the decline can be sudden and dramatic, with levels dropping by up to 50% within days of surgery.

FDA-approved testosterone products exist for women, despite decades of research supporting its clinical use

Source: Global Consensus Statement on Testosterone Therapy for Women, published in multiple journals, 2019

Beyond libido: what the research shows

The 2019 Global Consensus Statement on Testosterone Therapy for Women, endorsed by multiple international endocrine and menopause societies, concluded that the only evidence-based indication for testosterone therapy in women is hypoactive sexual desire disorder (HSDD) in postmenopausal women. However, the consensus also acknowledged that research into other potential benefits is ongoing and that the evidence base is expanding.

Mood and mental health

Research suggests that testosterone is associated with mood regulation in women. Androgen receptors are widely distributed in brain regions involved in emotional processing. Published data indicates that testosterone therapy may be associated with improvements in mood, well-being, and reduced depressive symptoms in some postmenopausal women, though results across studies have been inconsistent. Larger, longer-term trials are needed.

Cognitive function

Testosterone receptors are present in areas of the brain involved in memory and cognition, including the hippocampus and prefrontal cortex. Some observational studies have found associations between higher endogenous testosterone levels and better cognitive performance in postmenopausal women. However, interventional studies have produced mixed results, and this remains an active area of investigation.

Bone density

Testosterone contributes to bone health both directly (through androgen receptors on bone cells) and indirectly (through its conversion to estradiol). Published research has shown that testosterone therapy is associated with increases in bone mineral density in postmenopausal women. The Global Consensus Statement noted that while data on fracture prevention specifically from testosterone is insufficient, the effect on bone density is consistently positive across studies.

Energy and body composition

Clinical reports and some trial data suggest that testosterone therapy may be associated with improvements in energy levels and lean body mass in postmenopausal women. Testosterone plays a role in muscle protein synthesis and mitochondrial function. However, well-controlled trials specifically evaluating energy as a primary outcome are limited.

Cardiovascular markers

The relationship between testosterone and cardiovascular health in women is complex. The Global Consensus Statement found no evidence that physiologic-dose testosterone therapy increases cardiovascular risk in postmenopausal women over the study durations examined (up to 24 months). Longer-term safety data remains a significant gap.

A note on evidence quality: Much of the research on testosterone in women involves relatively small studies with short durations. The Global Consensus Statement emphasized the need for large, long-term, placebo-controlled trials. The absence of an FDA-approved product has contributed to the difficulty of conducting these trials at the scale needed.

Symptoms associated with low testosterone in women

Reduced sexual desire

Persistent fatigue

Low motivation or drive

Brain fog or reduced mental sharpness

Loss of muscle mass or strength

Depressed mood or flat affect

Reduced sense of well-being

Bone density loss

These symptoms overlap significantly with those of estrogen and progesterone deficiency, which is one reason testosterone is often overlooked in the clinical workup of perimenopausal and postmenopausal women.

The current prescribing landscape

In the absence of an FDA-approved product, clinicians who prescribe testosterone for women must use off-label approaches. The most common options include:

Compounded testosterone creams or gels: Custom-prepared by compounding pharmacies, these are the most widely prescribed form. Dosing is typically 1/10th to 1/20th of the standard male dose. Quality and consistency vary between pharmacies.
Male products at adjusted doses: Some clinicians prescribe FDA-approved male testosterone products (such as 1% testosterone gel) at reduced doses. This requires careful patient education about dosing.
Testosterone pellets: Subcutaneous pellets inserted every 3-6 months. Some clinicians prefer this for consistent delivery, though dosing control can be challenging once implanted.

The compounding controversy: Compounded hormones are not subject to the same regulatory oversight as FDA-approved products. The Global Consensus Statement and the Endocrine Society have both raised concerns about variable potency, sterility, and the lack of standardized safety testing for compounded testosterone formulations. At the same time, compounded products are currently the only practical option for many women, given the absence of an approved alternative.

What's happening in 2026

Telehealth expansion

Digital health platforms focused on menopause have increasingly incorporated testosterone into their treatment offerings. Companies specializing in women's midlife health have launched testosterone prescribing services, making access easier for women who previously could not find a provider willing to prescribe. This has accelerated public awareness but also raised questions about appropriate screening, monitoring, and follow-up.

Public advocacy

Celebrity advocacy has played a significant role in bringing testosterone for women into mainstream conversation. High-profile public figures have spoken openly about their experiences with testosterone therapy during the menopausal transition, helping to destigmatize the topic and encouraging women to discuss it with their providers.

Pharmaceutical development

Several pharmaceutical companies are pursuing FDA approval for female-specific testosterone products. Investigational products in various stages of development include novel delivery mechanisms (oral formulations, transdermal patches designed for female physiology) that aim to address the dosing precision and safety monitoring challenges of current off-label approaches. If approved, these would represent the first products specifically designed and tested for women.

50%

approximate decline in testosterone levels from a woman's 20s to her menopausal transition

Source: Davis SR, Wahlin-Jacobsen S, Lancet Diabetes & Endocrinology, 2015

What clinicians should know

The Global Consensus Statement provides the most authoritative current guidance for clinicians considering testosterone therapy for women:

Indication: The only evidence-supported indication is HSDD in postmenopausal women, after other causes have been excluded.
Dosing: Only formulations and doses that approximate physiological premenopausal testosterone concentrations should be used. Supraphysiologic dosing is associated with adverse effects (acne, hirsutism, alopecia).
Monitoring: Baseline and follow-up total testosterone levels should be measured. The goal is to restore levels to the premenopausal physiological range, not above it.
Duration: A trial of at least 3-6 months is needed to assess response. Long-term safety data beyond 24 months is limited.
Contraindications: Testosterone should not be used in women with hormone-sensitive cancers, polycythemia, or during pregnancy/breastfeeding.

Many patients are now presenting with specific questions about testosterone therapy, often informed by social media, podcasts, and telehealth marketing. Clinicians benefit from being prepared to discuss the evidence, set realistic expectations, and distinguish evidence-based use from wellness claims.

The measurement challenge

One significant barrier to advancing testosterone therapy for women is the measurement problem. Standard testosterone assays were designed for the male range and lack sensitivity at the lower levels found in women. The development of more sensitive assays (such as liquid chromatography-tandem mass spectrometry) is improving accuracy, but many clinical laboratories still use less precise immunoassay methods.

This measurement limitation means that "low testosterone" in women is difficult to define with precision, and that tracking response to therapy requires assays that many standard labs do not offer. It also means that the relationship between specific testosterone levels and symptoms in women is not as clearly established as it is in men.

What women can do now

Know your symptoms. If you're experiencing persistent fatigue, low motivation, reduced sexual desire, or cognitive changes during the menopausal transition, testosterone deficiency may be a factor worth discussing with your provider.
Track over time. Because hormone levels fluctuate, longitudinal tracking of symptoms and patterns is more informative than any single measurement.
Find the right provider. Look for clinicians with specific experience in menopause medicine. Certification from organizations like the Menopause Society (formerly NAMS) is a useful signal.
Approach with informed expectations. Testosterone therapy can be beneficial for the right patient, but it is not a universal solution for all menopausal symptoms.

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The bottom line

Testosterone is not a "male hormone." It is a critical part of female biology, and its decline during the menopausal transition is associated with symptoms that significantly affect quality of life. The science is advancing, advocacy is growing, and new treatment options are in development. But the regulatory gap remains, and women and their providers must navigate an imperfect landscape.

The most important step is awareness: understanding that testosterone matters for women, that its decline is measurable and meaningful, and that options exist even within the current constraints.

This article is for informational purposes only and does not constitute medical advice. MARKABLE is a general wellness product for personal awareness and self-monitoring. It is not a medical device and is not intended to diagnose, treat, cure, or prevent any disease. Always consult a qualified healthcare provider for medical guidance.